Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Friday, August 01, 2008

A "personal belief exemption" in California allows parents to refuse their child's normally required immunizations. I believe this to be the case in Boulder, Colorado as well, but since they are a "nuclear free zone" it may be a wash.

Many hug-the-earth types are refusing immunizations based on the belief that 'herd immunity' will save their crumb crunchers and avoid all the bad sequelae of immunizations like... uh... something? Autism?? Sorearmitis?

Fact, herd immunity breaks down with less than 90% immunity in the population. So, while we can argue dusk to dawn about your kids and your rights, you may actually be making decisions for the world in general, and, the third world specifically. What I mean is this, an outbreak of an otherwise vanquished disease will probably not be devastating to the U.S.A., but one traveller taking a communicable (and preventable) disease across the ocean, and passing it to one or two others, can kill a whole lot of kids in Somalia.

I'm at a conference right now with a nice doc from the CDC who just informed our group that in California, because of the above, we now have, again, measles. Thanks asswipes!

My son is one of those kids deathly allergic to the pertussis component of DPTs: He had to be resuscitated after his first one. Thus, we've never been able to fully vaccinate him, unfortunately. We rely on herd immunity to protect him, so other parents acting on their "personal beliefs" threaten my son's health.

Isn't it also true that since imunizations are not necessarily 100% effective that the people who don't get vaccinated and get the diseases also potentially put vaccinated children/people at risk? Just checking to see if my facts are accurate on this.

For the record, all 4 of my kids have had every vaccination their doctor recommended. I trust him completely, that is why he is their doctor and if he told me to set fire to my house to protect one of my kids, I'd probably do it. (but not really on the last part)

Check out respectful insolence blog. He goes on about autism. Also Mainstream parenting blog by Ester is a good source. The non-vax folks are a source of annoyance that starts me banging my head against the desk. I have a huge bruise on my forhead now.

and yeah, gaiai led them down to the valley of the jebusites, and she saith unto them, 'do not vaccinate your children... it causes me to have a fever... followest thou the gospel of gore... and go in never ending bliss to the land of the ignorami where you will drink honey and whey from the skullS of the vanquished (or the dead children)'.

OMG, one time when I got a tetanus shot when I was 10 it hurt soooo badly. And I felt sick for like a whole day!! Oh, wait, but I didn't get seriously ill from that rusty nail I stepped on.

Maybe it's because I don't have autism, but I'm very grateful for never having a terrible, preventable disease after hearing the stories from my older family members. And now kids may not even have to worry about chicken pox? I think that's fabulous.

Oh well. I went to college with some stupid bitch who didn't get immunized due to some fucked up religion. She was always getting sick with silly shit that nobody else had ever considered.

Who gets diptheria, chicken pox or any of that silly shit nowadays? That's why we have immunizations.

The only time I ever heard of that was playing Oregon Trail when Zed would die somewhere in Utah and we'd leave a tombstone for him after shooting 1200 pounds of meat.

Those silly fuckers get what they deserve: disease.

Only thing: If they are on medicare or medicaid, it should be mandatory or they get dropped from the program. I'm not paying for their fucking 'freedoms' by cutting short my free time so I can work to pay for their health care.

Job is going slow but steady. Have not actually started. We are just getting bids for construction and going through all the f**king red tape that some boil-ass pencil pusher thought it would be great to have. Oh well, I hope that light at the end of the tunnell isn't a train.

Both of my parents had polio when they were kids. My dad actually caught it from the Sabin vaccine. He was in one of the first batches of kids to get vaccinated with it. (But his parents didn't sue so we're not rich or anything, sigh.)

Dr Cat:Actually a train wreck would solve all your problems. I'm on my honeymoon in the Pacific Northwest, all expenses paid for by a certain city in the Golden State which didn't respond to cyclist emails (all of which I got copies of) about bike trail hazards. Anyhoo, my husband was thrown from his bike and lost his four front teeth. And att last all my fantasies re hillbillies are fulfilled!

it's back. now i can forgive the Amish for not vaccinating their kids. they live in largely closed communities and are the most self sufficient folks i have met. they drive around in horse-drawn buggies and don't use electricity in some communities. in a word, they are consistent. they also rarely go to the ER. warning, if there is an Amish person checking in to your ER they are sicker than shit. their objections to vaccination are, i believe, wrong, but i respect them.

the granola crowd is another story. i would never worry about being sued by an Amish family for not adequately explaining to them the danger of non vaccination, but i guarantee you that if i were a pediatrician in boulder and some non-vaccinated kid got measles from airborne exposure while in my clinic, that they would slap a lawsuit on me so fast my head would spin. there would be letters to the editor and candlelight vigils and take back the night marches. this would be two weeks after having to endure a lecture at the hands of the angry mother explaining to me how i was trying to kill her child by immunizing them against... measles. yes, i have had mothers yell at me about 'pushing' vaccination. yell.

All I got to say is keep the unvaccinated kids away from my vaccinated kids. My kids have gotten every vaccine recommended by their dr to include flu shots every year and pneumonia shots. My 9 1/2 year old daughter will be getting the gardasil vaccine as well. We discussed it with our pcp and she said a lot of parents were opting out due to a moral objection that their kids won't have sex. I told her well if she does or doesn't, she will be protected regardless.

I really dislike people that don't vaccinate. Just let them sit there in a hospital and watch their kid die from Whooping Cough because they didn't vaccinate. Bet the next will be.

Thanks 911, that makes me feel all warm and fuzzy. I need a pick-me-up anyway. It is easy to get down on yourself as a stay at home mom because you sacrifice so much for your kids. Your body, your mind, your time, your sanity...the list just goes on and on.

miss missy,You're going to absolutely count on your child to never have a sexual contact before they are 14? I lost my virginity at 11--and not by choice, DESPITE having the most insanely overprotective parents on the planet.

If that guy had given me HPV or another STD, it would have made a terrible situation that much worse.

Interesting comments about vaccines.....Here's some thoughts from those of us in the business:

Antibody production (not sure of the mechanism yet) goes down as we age. Thus, booster shots are recommended for those who travel to endemic areas, particularly with measles (both) & mumps. Thats the whole theory behind Zostavax - all of us who had chicken pox as children have immunity. But, as we age, our immunity goes down (which allows shingles to develop) AND our antibody production goes down as well (thus allowing shingles to develop). So - Zostavax "boosts" the immunity. That doesn't mean you won't develop shingles (after all - the virus stays with you a lifetime), but your shingles outbreak might be less invasive (with less morbidity) or not at all.

There is discussion in the CDC about adding booster shots to some job classifications (some hospital workers, international airport medical clinic workers, etc) who are exposed to airborne diseases from immigrants or visitors from endemic areas where measles is a particular problem, We already know hospital workers have a higher incidence of PPD conversions due to treating immigrants & visitors who come with active TB.

Gardisil is recommended in the pediatric immunization guidelines & is given under age 14 because that is usually when their normal series ends. After the routine vaccinations are done, tweens & teens don't have regular appointments unless they have a chronic illness (asthma) or have to get their meningococcal vaccine to go to college. Its a 3 shot series, over 6 months - far easier for mom & dad to schedule it with the normal well child checks.

There is NO reason not to get the new vaccine which contains pertussis now, unless you have an allergy to egg or gelatin. Its called Adacel. The protein end of the pertussis has been removed and there is no longer generating adverse effects - look it up! Pertussis is on the rise & is a particularly difficult disease to diagnose (& treat btw). Very few physicians have ever seen pertussis so its not on their radar. The five I've seen treated had the disease for months & were ultimately diagnosed by a pulmonolgist after months of tests, brochial washes. It took an expensive antigen test to actually diagnose.

Tetanus shots hurt because the protein is very, very large. There is no getting around it - its just a big protein which is going into a muscle. That generates a whole physiology of reactions - including fever, aching, etc. We give that as a warning ahead of time & it is a reliable reaction.

Autism is sad & I empathize with parents of autistic children. But, vaccinations are easy targets & they are given at the time when language is developing. But, that does not mean its causal & in fact has not been shown to be so. There is one case which is being considered right now, but so far the case is not going well for the parents.

Why not a leukemia vaccine? There is work on one right now. But, the etiology of leukemia is complicated & at the cellular level, not well known.

Gardisil (& the one in the pipeline which immunizes against 7 HPV viruses & will be indicated for boys & girls) had been worked on for more than 30 years. The original work was on the tobacco mosaic virus & investigators found similarities with HPV. Along the way, they found HPV was a carcinogen, but didn't realize that until much later.

The work on Gardisil is being translated to research in many other areas in which viral exposure is speculated to be part of the disease process - such as MS. Who knows where that will lead?????

Thanks Anonymous, that was very informative. I am so tired of everyone saying that the Drug companies say you should do it, so just do it. I need more information than that. I will continue to research this subject. I appreciate any information I can find on this.

Don't worry once the measles pandemic hits it will be followed by the stories of kids with measles encephalitis and subacute sclerosing panencephalitis to follow. If I recall the rates of encephalitis are as high as 1/200?. Just have to make it out alive past the first wave and then you get to listen to all the parents lament that doctors never explained the dangers of these diseases.

So explain this, my doctor promotes vaccines, but he has literature in his office against the use of similar vaccines for animals in our food supply? Herd immunity isn't just for humans folks. Sometimes doctors seem to forget these concepts even though veterinarians are often the ones to credit for many of these vaccines.

BTW - My fully vaccinated roommate is an autism researcher.

As an aside, can't we get these parents to sign a statement that says "My personal belief is that my child should not be vaccinated; however, if my child is infected with a preventable disease because of these beliefs, I am willing to accept full legal and financial responsibility, including, but not limited to, charges of 1st degree murder."

Hey Doc,I was surfing around Yahoo Shine (ok, yea a girly site) and found some talk about anti-vaccine BS. I pop onto another site, cookie magazine or something and yea there is a whole uprising against Amanda Peet and her words to parents who don't get their kids vaccinated.You should read the idiots responses to my reason, credible data etc.They give me BS sites that talk about aliens, organic food and praying to the worm gods.People are just nuts.

My daughter had serious barain damage after taking her DPT shot.Now she is 21 and totally dependent for her evry day needs and may be at mental age of 2 or three months old. We got her vaccine in good faith too but it changed her and our lives for ever. I think getting kids vaccinated should be an informed choice , one should not be forced.

I understand your point. It is a very good one. However, many people have concerns about the immunizations themselves as being harmful to the immune system. There are some articles coming out about these things in professional journals. I think to catagorize people with concerns as having a herd mentality is the sign of a closeminded person. Also the calling of such persons "asswipes" is not professional either.

I think the real herd mentality is to take any immunization the Medical Establishment and Big Pharma wants to foist upon people without doing any research.

Instead of just denouncing people who are opening their minds and questioning, why don't you encourage people to do research on both sides of the issue, and help lead them in some informative directions? You could be part of the solution, not just a mouth.

I was very interested in this blog at first but there is a juvenile attitude and so much anger that it is a turn off. I would love to read about what Doctors think and go through and some thoughts about issues from lots of different perspectives.I am studying to be a Nurse and hope to be a Nurse Practitioner. I just finished a class on Complimentary medicine. It was fascinating. It is my belief that Allopathic Medicine is not the only game in town. I see patients all the time in my work taking one pill and then taking another pill to help with the side effects of the first, until they have a handful of pills to swallow at each med pass. Something is wrong with this if you ask me.

It's not that I'm against immunizations. I'm just against the herd mentality that says a person must do and take everything that a select group of people want to demand. I believe people would not be so distrustful of 'conventional medicine' if Doctors and the powers that be would take a more respectful attitude to us peons and give us some credit for wanting to think for ourselves. People are tired of the Paternal Godlike attitude Drs and other med. establishment types have. People have the Internet now, for better or worse.

Btw, I just finished taking my booster shots not long ago to return to school.

you are correct. 'teen beat' and 'tiger beat' just came out with some articles on the danger of immunizations. they are, like, really good.

also, and just to be clear, i did not characterize these folks as being of the 'herd mentality', what i said was that the argument against immunizations, such as it is is based on the 'herd immunity' theory.

there are two sides on this issue, one is, in almost every case, wrong and dangerous.

but your last point is probably correct, i shouldn't just call all the non-immunizers asswipes, i should reserve that epithet for folks who prove them worthy... like yourself!

immunizations are not 'controversial', they are only 'controversial' with muddle headed people educated beyond their intelligence who believe that there is no real 'right' or 'wrong' but only 'what is right for you' or 'what is right for me'.

you have important decisions to make if you are going to pursue a career in medicine. do you practice based on evidence or on conspiracy theories? the latter is attractive because it's easy and requires no deep thought. good luck.

kr:I encourage you to research vaccines and make a critical decision about their use. You really strike me as the type of person that is well versed in complex medical decision making with your whole 4 months of nursing school. You are absolutely right that "the internet", as you call it, is now available to all, and those things we doctors have hidden from the masses so well in our publically available medical journals all those years can now be perused by wizards like yourself with a high school education and 15 viewings of 'Erin Brockovich'. I mean, wow, I don't even need a lawyer with multiple years of schooling and practice to assess arcane legal issues for me. I just google "writ of mandamus" and lo! I can go in front of the supreme court. I think that's a peachy idea to make life-changing, complex decisions without expert guidance. I also highly recommend aromatherapy for gram-negative sepsis. I think some 'professional journals' have discussed this.

I can't belive you think this blog is juvenile! Because I'm rubber and you are glue. No tradsies.

first of all i am tremendously sorry that your daughter got very sick and suffered brain damage.

i wonder if you might tell us more about what happened.

since the dpt vaccine is given to many millions of children every year without this terrible result i wonder if you can tell us more?

in medicine we often speak of illnesses as being 'true, true, and unrelated.'

in other words, i wonder if your child got meningitis or encephalits in the peri-vaccination period and the proximity of the vaccination was merely coincidental? what did the pediatrician/intensivist/ neurologist SAY happened.

you may not believe their explanation but it would be helpful to all readers here to hear it.

so sorry about your daughter, she is obviously very lucky to have such a caring mother.

I had 3 children. They were all immunized up until adulthood. I was the one who took them to their appointments. I didn't say I was a non-immunizer. I have had all my immunizations, as well.

I don't think you got very little of what I was trying to say, and wasn't above making fun of me as well.

I'm a dude-ette, btw.

I do think that each person has a responsibility to question and research what health tmts are being recommended to by medical personnel and that goes double for what goes on for their children. One of the books my dear old dad told me to read was: "The Cry and the Covenant" about Ignaz Phillip Semmiweis. If you have read I'm sure you would identify with the good Doctor seeing needless people suffer and die because of a simple thing like handwashing. On the other hand, many of his colleagues gave him true hell on earth because of his take on truth. They were as closed minded as people could get. They felt they were above this hick-y ol' Hungarian. Might there be some cause for concern over immunizations? I don't know...But I would be willing to examine more of what people's objections are about. My Dad was a very smart man. He got his GED in the Navy and worked as a machinist and milwright and a maintenance foreman at Whirlpool. Yet he read lots of things outside of his world. I read too.

Anyway, thanks for making me think about such an important topic as immunizations. I wouldn't have put it the way you did, but obviously your education has improved your vocabulary and people skills in a way that surpasses my humble understanding.

This is really stupid of me to return here, but I will tell you something. My husband went to a specialist for a problem. The Dr. treated him and then went on a 2 wk vacation. My husband's condition worsened and I called the Drs. The one on call told me I could take him to the ED if I wanted to, "Honey" but they didn't know what could be done for him. When his "specialist" came back I was with my husband and I had a library book in my hands about the condition. This Dr. told my husband to go immediately to the hospital and he said very arrogantly to me, to put down that book and take him there. I will never forget it. I will never forget something else. I took the book with me to the hospital and realized as I read, that this man was guilty of malpractice.

My husband suffered irreparable nerve and organ damage as the result of this Doctor. My husband killed himself 11 months later. That was 18 years ago but it has changed my life and the lives of my children forever.

It opened my eyes about alot of things, including one's responsibility to self and family, and to be as educated as you can be about certain things.

I learned about this blog from the Blogs of Note section. I guess it really isn't for me. I'll go back to conspiracy theories and comic books. Ciao.

let me say that i am very sorry we jumped on you so much earlier. good for you for coming back.

it's just that you seemed to be one foot in the door with western medicine and yet making important decisions based on emotion and this is a huge problem every day for me in the ER. it's one of the reasons i'm leaving practice. now, let me address your last comment in a serious and caring fashion (no shit).

you are correct that, if the story you tell is on the money, that you had a couple of first class assholes there as physicians.

once someone becomes MY patient i WANT them to learn about their disease. you wanting to learn about it SHOULD have made them happy.

if you feel comfortable tell us more about your husbands condition and, specifically, what was done wrong the first time.

please do continue to visit here. the dogs are called off. you seem to really want to learn more and that is FANTASTIC.

i'll tell you what. if you want to talk about this with me by email i would be more than happy to. it might ease your mind and give some insight as to the causes, avoidable and otherwise, about what happened to your husband.

again, many apologies, and you are always welcome here.

it is very true, and was ESPECIALLY true in the time frame that you mention, that the 'god complex' physicians were more numerous.

again, if the story is as you say then you and your husband were terribly mistreated.

the anger and cynicism you see here is not primarily directed at patients, it is directed at the power brokers in medicine, most of whom are not physicians or are failed physicians, putting up barriers to care.

the public blames us, for the most part, and this does make us angry.

people, apparently on the exact OPPOSITE end of the spectrum from you, do get us all fired up because they do not take ANY RESPONSIBILITY for their own health or for managing their own problems. please do contact me either through the blog or by the email at the upper right.

and as long as we are talking about it, why not be a nurse practitioner or PA or a physician?

Thanx 911 doc, for your nice words. I will soon get some info together to share with you , about my daughter`s illness. It was really nice to see, that you have a kind heart .Which we expect from all of our physicians, and sadly get disappointed. (mom of 21 year old )